Healthcare Provider Details

I. General information

NPI: 1073336251
Provider Name (Legal Business Name): PNS OF FLORIDA VI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 NW 87TH AVE STE 500
DORAL FL
33178-2433
US

IV. Provider business mailing address

3750 NW 87TH AVE STE 500
DORAL FL
33178-2433
US

V. Phone/Fax

Practice location:
  • Phone: 305-284-7484
  • Fax:
Mailing address:
  • Phone: 305-284-7484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JOSE PELAYO
Title or Position: CEO
Credential:
Phone: 305-284-7484